Pregnancy Does not Affect the Prognoses of Differentiated Thyroid Cancer Patients With Lung Metastases

Abstract

Context Pregnancy-related hormones may stimulate thyroid cancer growth, but whether pregnancy affects the prognoses of patients with lung metastases from differentiated thyroid cancer (DTC-LM) after surgery and radioiodine therapy is unclear. Objective To assess the impact of pregnancy on DTC-LM through the comparison of prognoses between female patients with DTC-LM who did and did not become pregnant after surgery and radioiodine therapy. Methods We retrospectively analyzed the records of 124 female patients aged 16-35 years who underwent surgery and radioiodine therapy for DTC-LM. These patients were divided into pregnancy group (n=37) and non-pregnancy group (n=87) according to whether they became pregnant after surgery and radioiodine therapy, regardless of whether they had a pregnant history before treatment. Results The 5- and 10-years PFS rates were 94.52% and 63.22% in pregnancy group versus 89.82% and 58.13% in non-pregnancy group. The 5- and 10-years cumulative OS rates of pregnancy group is 97.30% and 85.77% versus 93.50% and 81.95% in non-pregnancy group (all P>0.05). The median time of follow-up in the pregnancy and non-pregnancy group was 82 months (25-136 months) and 68 months (13-133 months), respectively. Non- 131I-avid LM and primary tumors needing repeated resection were independent predictors of poor PFS for patients in pregnancy group. Conclusion Pregnancy does not affect the prognoses of patients with DTC-LM after surgery and radioiodine therapy. Non- 131I avid LM and repeated primary tumor surgeries are independent risk factors for poor prognoses of pregnant patients.

Clinical course and outcome of differentiated thyroid cancer patients with pregnancy after diagnosis of distant metastasis

“…Previous studies have shown no differences in the survival, recurrence, or death between pregnancyassociated thyroid cancer and cancer in age-matched non-pregnant women [10] However, a more recent study reported that persistence/recurrence of DTC is signi cantly higher in pregnant patients, suggesting that pregnancy could exert a negative prognostic role in DTC patients, and more careful follow-up is needed in patients who are diagnosed with DTC during pregnancy or shortly thereafter [25]. Xi et al reported that the 10-year PFS and OS rates were 63.22% and 85.77%, respectively, in the pregnancy group (n = 37) versus 58.13% and 81.95%, respectively, in the non-pregnancy group (n = 87); thus, pregnancy does not affect the DTC prognoses in patients with lung metastasis [13]. In this study, the 10-year PFS rate (92.1%) was better than that in a previous study.…”

“…However, to our knowledge, there is no evidence showing that pregnancy worsens the prognosis of thyroid cancer [12,13]. Xi et al revealed that pregnancy does not affect the prognoses in DTC patients with lung metastasis [13].…”

“…Pregnancy-related hormones, such as estrogen and human chorionic gonadotropin, may favor the growth, progression, and spread of thyroid tumors [10,11]. However, to our knowledge, there is no evidence showing that pregnancy worsens the prognosis of thyroid cancer [12,13]. Xi et al revealed that pregnancy does not affect the prognoses in DTC patients with lung metastasis [13].…”

Pregnancy and the prognosis of patients previously treated for differentiated thyroid cancer: a systematic review and meta-analysis

“…Structural recurrence/progression was defined as appearance of new local/metastasis lesions, or 20% or more increase in size of a pre-pregnancy lesion 12,13 . Biochemical recurrence/progression was defined as 20% or more increase in serum thyroglobulin (Tg) from the pre-pregnancy level and/or consistent increase of 20% or more in serum anti-Tg antibodies 10,12 .…”

“…Up to now, two Italian studies reported significantly higher risk of recurrence in patients who were diagnosed with DTC during pregnancy or soon after delivery 8,9 . As for DTC patients diagnosed and treated before pregnancy, a Chinese study claimed pregnancy has no impact on prognosis 10 . Discrepancy across studies may be attributed to the varied time of diagnosis (during pregnancy or prior to pregnancy), study design (single-group study or study with comparison group), or patients with different response to therapy status.…”